Hope lies when people rise-up
"The prevalence of hepatitis C virus infection among people who inject drugs in the state capital of Manipur, India, is 65%. However, access to and uptake of hepatitis C care is poor, largely due to lengthy pre-treatment processes. That is why we piloted a community-led, comprehensive, simplified hepatitis care model that includes same-day hepatitis C virus testing and treatment initiation ("test and treat") at drug rehabilitation centres in Manipur, to expand access to care for chronic hepatitis," reads this study publication.
Testing for hepatitis C virus involves few steps: first, screening is done for hepatitis C antibodies. But this test will not distinguish between acute, chronic or resolved hepatitis C infection. That is why all those who test positive for hepatitis C antibody, are offered hepatitis C RNA viral load test using technologies such as RT-PCR or molecular test (or nucleic acid amplification test) such as Gene Xpert or TrueNat. Hepatitis C viral load test will confirm those with acute and chronic infection of hepatitis C, and exclude those whose infection has got resolved.
In Manipur, viral load tests are only available in the state capital Imphal. Machines to do viral load tests (TrueNat machines) are available but trained and dedicated human resource to manage these are not available.
"Since the programme was launched in Manipur in 2019, the number of people on hepatitis C treatment has been very low," points out Nalinikanta Raj Kumar of CoNE.
Kumar has been part of several community-led initiatives to improve hepatitis and HIV care in Manipur. One of them is the ongoing Community Treatment Observatory process, which was set up in early 2021 with support from International Treatment Preparedness Coalition (ITPC) and TREAT Asia programme.
The phase-1 report of Community Treatment Observatory has already had a positive impact on HIV and hepatitis programmes in the state. One of the impacts has been to shorten the turnaround time of hepatitis C RNA viral load test report from 30-45 days to 5-7 days. Now, new evidence for "same-day test and treat" model will hopefully impact change. Another positive change is that the process for recruiting community peers in the hepatitis care services is moving forward.
Another obstacle reported by those in need for hepatitis care is the mandatory requirement to have a government-issued identity card to access care and services, including hepatitis-C treatment. HIV and hepatitis C co-infection is common, so confidentiality issues hover along with the reality that everyone does not possess a government-issued identity card.
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